No plan survives its first contact with reality, particularly those that aim high. There will always be unforeseen glitches when trying something new, especially in a complex environment such as a hospital. Start small and scale quickly utilizing rapid cycles of action-oriented learning. The "popular–do–study–act (PDSA)" model is successful in this scenario.

Start by planning (plan) your intervention, and then test (do) it. The next step (study) is critical. Observe the test yourself, paying close attention to competing demands and physical space.It is important to ask those involved in the test what worked... what did not... and listen carefully. Ask them for alternative ideas, pitch your own and talk it out. This process will enable you to learn what could or should be done differently from how your team originally planned it. The last step is to set things up to do better next time (act).

No matter where you are in the spectrum, SHM can assist you in your efforts. SHM encourages you to join the QI community and view the calendar for up to date information on key events and discussions around the quality and innovation movement.